NHS3

Why, where and who created the NHS

National Health Service leaflet, May 1948

Dr Benjamin Moore, a Liverpool physician, was probably the first to use the words 'National Health Service' in 1910. He established the State Medical Service Association which held its first meeting in 1912 and continued to exist until it was replaced by the Socialist Medical Association in 1930.

Before the National Health Service was created in 1948, patients were generally required to pay for their health care. Free treatment was sometimes available from Voluntary Hospitals. Some local authorities operated hospitals for local ratepayers (under a system originating with the Poor Law). The London County Council (LCC) on 1 April 1930 took over from the abolished Metropolitan Asylums Board responsibility for 140 hospitals, medical schools and other medical institutions. The Local Government Act 1929 allowed local authorities to run services over and above those authorised by the Poor Law and in effect to provide medical treatment for everyone. By the outbreak of the Second World War, the LCC was running the largest public health service in Britain.

The Emergency Hospital Service established in 1939 gave a taste of what a National Health Service might look like.

Systems of health insurance usually consisted of private schemes such as Friendly societies or Welfare societies. Under the National Insurance Act 1911, introduced by David Lloyd George, a small amount was deducted from weekly wages, to which was added contributions from the employer and the government. In return for the record of contributions, the workman was entitled to medical care (as well as retirement and unemployment benefits) though not necessarily to the drugs prescribed. Lloyd George's name survives in the "Lloyd George envelopes" in which most primary care records in England are stored, although records are now becoming computerised. This imperfect scheme only covered workers who paid their National Insurance Contributions and was known as 'Lloyd George's Ambulance Wagon'. Most women and children were not covered.

Lord Dawson was commissioned in 1919 by Lord Addison, the first British Minister of Health to produce a report on medical services in Great Britain. An Interim Report on the Future Provision of Medical and Allied Services was produced in 1920, though no further report ever appeared. The report laid down plans for a network of Primary and Secondary Health Centres, and was very influential in subsequent debates about the National Health Service. However the fall of the Lloyd George government prevented any implementation of those ideas at that time.

Image: The National Archives • Believed to be in the Public Domain (Age - Copyright expired)

Photo: Lilywhite Ltd • Believed to be in the Public Domain (Age - Copyright expired)

Park Hospital, Davyhulme, Manchester.
The first NHS Hospital

The Labour Party in 1932 accepted a resolution moved by Somerville Hastings MP calling for the establishment of a State Medical Service and in 1934 the Labour Party Conference at Southport unanimously accepted an official document on a National Health Service.

Prior to the Second World War there was already consensus that health insurance should be extended to the dependants of the wage-earner, and that the voluntary and local authority hospitals should be integrated. A British Medical Association (BMA) pamphlet, "A General Medical Service for the Nation" was issued along these lines in 1938. However, no action was taken due to the international crisis. During the war, a new centralised state-run Emergency Hospital Service employed doctors and nurses to care for those injured by enemy action and arrange for their treatment in whichever hospital was available. The existence of the service made voluntary hospitals dependent on the Government and there was a recognition that many would be in financial trouble once peace arrived. The need to do something to guarantee the voluntary hospitals meant that hospital care drove the impetus for reform.

In February 1941 the Deputy Permanent Secretary at the Ministry of Health recorded privately areas of agreement on post-war health policy which included "a complete health service to be available to every member of the community" and on 9 October 1941, the Minister of Health Ernest Brown announced that the Government proposed to ensure that there was a comprehensive hospital service available to everyone in need of it, and that local authorities would be responsible for providing it. The Medical Planning Commission set up by the professional bodies went one stage further in May 1942 recommending (in an interim report) a National Health Service with General Practitioners working through health centres and hospitals run by regional administrations. The Beveridge Report of December 1942 included this same idea.

Developing the idea into firm policy proved difficult. Although the BMA had been part of the Medical Planning Commission, at their conference in September 1943 the association changed policy to oppose local authority control of hospitals and to favour extension of health insurance instead of GPs working for state health centres. When Health Minister Henry Willink prepared a white paper endorsing a National Health Service, it was attacked by Brendan Bracken and Lord Beaverbrook and resignations were threatened on both sides. However the Cabinet endorsed the White Paper which was published in 1944. This White Paper includes the founding principles of the NHS: it was to be funded out of general taxation and not through national insurance, and services would be provided by the same doctors and the same hospitals.

Aneurin Bevan became Minister of Health in Clement Attlee's Labour Party government after the war ended. Bevan quickly came to the decision that the 1944 white paper's proposal for local authority control of voluntary hospitals was not workable, as the local authorities were too poor and too small to manage hospitals. He decided that "the only thing to do was to create an entirely new hospital service, to take over the voluntary hospitals, and to take over the local government hospitals and to organise them as a single hospital service". This structure of the NHS in England and Wales was established by the National Health Service Act 1946 which received Royal Assent on 6 November 1946. Bevan encountered considerable debate and resistance from the BMA who voted in May 1948 not to join the new service, but brought them on board in time for the official launch of the NHS, 5 July 1948.

The NHS began on 5 July 1948. it was the climax of a hugely ambitious plan to bring good healthcare to all. For the first time, hospitals, doctors, nurses, pharmacists, opticians and dentists were brought together under one umbrella organisation to provide services that are free for all at the point of delivery.

The NHS instantly became Britain's 3rd largest employer with around 364,000 staff across England and Wales. These included 9,000 full-time doctors, 19,000 professional and technical staff (including 2,800 physiotherapists, 1,600 laboratory technicians and 2,000 radiographers), 25,000 administrative and clerical staff, 149,000 nurses and midwives (23,000 of whom were part-time), and 128,000 ancillary staff (catering, laundry, cleaning and maintenance).
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Currently, the NHS is the largest employer in Europe and the 5th largest in the world (after The United States Department of Defence, The Chinese People's Liberation Army, US shopping giant Wallmart and food chain McDonald's.

Three years after the founding of the NHS, Bevan resigned from the Labour government in opposition to the introduction of charges for the provision of dentures and glasses. The following year, Winston Churchill's Conservative government introduced prescription charges. These charges were the first of many controversies over reforms to the NHS throughout its history.

The NHS will last as long as there are folk left with faith to fight for it. Nye Bevan, 1952

Source: Wikipedia.org

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